New report warns that excessive use will lead to adverse drug reactions
AT LEAST 50 per cent of antibiotic use in hospitals is inappropriate, according to a new report from the national Health Protection Surveillance Centre (HPSC) which yesterday published guidelines on proper antimicrobial stewardship in hospitals in Ireland.
The report warns that in addition to promoting antimicrobial resistance, excessive or inappropriate use of antibiotics is associated with avoidable adverse drug reactions with implications for patient safety.
It recommends all acute hospitals develop an antimicrobial stewardship programme led by a medical microbiologist or infectious diseases consultant, that national treatment guidelines be developed for treating common infections in hospital, and that there be restricted availability of specific antibiotics within hospitals.
It also says that all hospitals should have an ongoing programme of education for prescribers, that all acute hospitals should have round-the-clock access to an accredited microbiology laboratory, and that hospital managers should include rational antibiotic use as a strategic goal for their hospital.
The report acknowledges that “in many healthcare settings in Ireland it will not be possible to implement” much of what is recommended despite the best efforts of staff “because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally”.
However, Dr Robert Cunney of the HPSC stressed that if the guidelines were adhered to, they would actually save money in the long run. He said studies showed outcomes for patients would also be greatly improved.
“It is one of the few medical interventions that pays for itself,” he stressed. For example, an antimicrobial pharmacist appointed to a hospital in the midlands a few years ago, he said, was proven to have saved the hospital three times her own salary in her first year.
Dr Cunney said that internationally an estimated 50 per cent or more of hospital antimicrobial use was inappropriate, either because drugs were used which were inappropriate or they were used in the wrong dose for the wrong duration of time. Even the 50 per cent figure would be on the “conservative” side, he believes.
“A lot of it is related to the fact that at least up until recently in most hospitals in Ireland and internationally you didn’t have the relevant experts in place to really guide antibiotic therapy”.
And while the report says hospital antimicrobial consumption in Ireland is high compared with most European countries, Dr Cunney said there was a 5 per cent drop in antibiotic use in hospitals here in 2008 compared with 2007.
New guidelines have also been produced by the HPSC in a bid to reduce catheter-related infections such as MRSA. Ireland continues to have one of the highest rates of MRSA infection among 31 European countries, the report says.
